[Association between e-cigarette advertising exposure and e-cigarette use in adolescents in China]

Objective: To describe the current status of electronic cigarette advertising exposure in adolescents in China and evaluate the association between e-cigarette use and e-cigarette advertising exposure. Methods: Multi-stage cluster random sampling method was used to select 840 schools from 14 provinces in northeastern, northern, central, southern, northwestern, southwestern and eastern China. The schools included junior high schools, senior high schools and vocational senior high schools. In the survey, the students completed the questionnaires anonymously in campus. Logistic regression analysis was conducted to evaluate the association between exposure to e-cigarette advertising and e-cigarette use. Results: A total of 113 133 secondary school students completed this survey, the response rate was 95.7%. Within the past 30 days, the weighted exposure rate of e-cigarette advertising was 22.6%, with a higher percentage in girls (23.6%) than in boys (21.8%). The highest weighted exposure rate of e-cigarette advertising was found in vocational senior high school students (26.7%), followed by senior high school students (24.8%) and junior high school students (20.6%) (all P<0.001). The three most common channels through which secondary school students were exposed to e-cigarette advertising were electronic cigarette experience stores or e-cigarette retail stores (10.3%), shops/supermarkets/convenience store/grocery stores (9.9%), and internet (8.4%). The logistic regression analysis indicated that exposure to e-cigarette advertising in the past 30 days was a risk factor for the current use of e-cigarettes in adolescents in China (OR=2.58, 95%CI: 2.17-3.06, P<0.001). Conclusions: Adolescents can be exposed to e-cigarette advertising through multiple channels in China. It is necessary to strengthen the implementation of relevant laws to protect adolescents from e-cigarette use.